Serotonin Syndrome

Serotonin syndrome is often described as a clinical triad of mental status changes, autonomic hyperac-tivity, and neuromuscular abnormalities, although not all of these findings are present in all patients with this disorder (Boyer and Shannon 2005; Brown et al. 2000). An excess agonism of the central and peripheral nervous system serotonergic receptors is caused by a range of drugs, including SSRIs, monoamine oxidase inhibitors (MAOIs), valproate, dex-tromethorphan, lithium, meperidine, and fentanyl. Drug-drug interactions that can cause serotonin syndrome include linezolid (an antibiotic that has MAOI properties) used with an SSRI, as well as combinations of SSRIs, trazodone, buspirone, venlafax-ine, ondansetron, metoclopramide, and sumatriptan (Boyer and Shannon 2005). Serotonin syndrome is often self-limited and may resolve spontaneously after discontinuation of the serotonergic agents. Se vere cases require control of agitation, autonomic instability, and hyperthermia as well as administration of 5-HT2A antagonists (cyproheptadine). The syndrome can be difficult to clinically separate from NMS or anticholinergic "toxidromes" (Choi-Kain and Pope 2007) (see Table 30-6).

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